MP80-02 COST-EFFECTIVENESS ANALYSIS OF 99M TC-SESTAMIBI SPECT/CT TO GUIDE MANAGEMENT OF SMALL RENAL MASSES

You have accessJournal of UrologyKidney Cancer: Epidemiology & Evaluation/Staging/Surveillance III (MP80)1 Apr 2020MP80-02 COST-EFFECTIVENESS ANALYSIS OF 99MTC-SESTAMIBI SPECT/CT TO GUIDE MANAGEMENT OF SMALL RENAL MASSES Zhuo T. Su*, Hiten D. Patel, Mitchell M. Huang, Alexa R. Meyer, Christian P. Pavlovich, Phillip M. Pierorazio, Mehrbod S. Javadi, Mohamad E. Allaf, Steven P. Rowe, and Michael A. Gorin Zhuo T. Su*Zhuo T. Su* More articles by this author , Hiten D. PatelHiten D. Patel More articles by this author , Mitchell M. HuangMitchell M. Huang More articles by this author , Alexa R. MeyerAlexa R. Meyer More articles by this author , Christian P. PavlovichChristian P. Pavlovich More articles by this author , Phillip M. PierorazioPhillip M. Pierorazio More articles by this author , Mehrbod S. JavadiMehrbod S. Javadi More articles by this author , Mohamad E. AllafMohamad E. Allaf More articles by this author , Steven P. RoweSteven P. Rowe More articles by this author , and Michael A. GorinMichael A. Gorin More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000972.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Incidentally detected small renal masses (SRMs) may be one of several benign or malignant tumor histologies and are heterogeneous in oncologic potential. Although renal mass biopsy (RMB) can be used to determine the histology of SRMs, this invasive approach has significant limitations. 99mTc-sestamibi single photon emission computed tomography/computed tomography (SPECT/CT) is a promising imaging tool that can aid in identifying benign renal oncocytomas and hybrid oncocytic/chromophobe tumors. We conducted this study to evaluate the clinical and economic value of 99mTc-sestamibi SPECT/CT in guiding the management of SRMs. METHODS: We developed a decision analytic Markov model to estimate the costs and health outcomes of managing a healthy 65-year old patient with an asymptomatic SRM using competing strategies, including empiric partial nephrectomy (PN; reference arm); RMB (option 1); 99mTc-sestamibi SPECT/CT (option 2); and 99mTc-sestamibi SPECT/CT followed by RMB to confirm benign SRMs (option 3). We assessed lifetime health utilities, measured in quality adjusted life-years (QALYs), and direct medical costs from the perspective of health care payers in the United States. We calculated the incremental cost-effectiveness ratio (ICER) for options 1-3 versus the reference arm, with a willingness to pay threshold of $50,000/QALY. A secondary analysis compared options 1-3 versus real-world clinical practice (RWCP) consisting of empiric surgery, thermal ablation and active surveillance. RESULTS: Option 3 had a very low risk of untreated malignant tumors (0.2%, vs. 2.1% for option 1, 4.2% for option 2, and 0% for empiric PN) and the highest probability of leaving benign tumors untreated (84.4%, vs. 53.9% for option 1, 51.7% for option 2, and 0% for empiric PN). Option 3 dominated empiric surgery and options 1 and 2 (i.e. lower costs and higher QALYs; Table 1). Compared to RWCP, options 1-3 were all cost-effective; option 3 had the lowest ICER of $18,821/QALY. These findings were robust to alternative input values. CONCLUSIONS: 99mTc-sestamibi SPECT/CT followed by confirmatory biopsy helps avoid unnecessary treatment of benign SRMs, minimizes risks of untreated malignant SRMs, and is cost-effective versus existing strategies. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e1224-e1225 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Zhuo T. Su* More articles by this author Hiten D. Patel More articles by this author Mitchell M. Huang More articles by this author Alexa R. Meyer More articles by this author Christian P. Pavlovich More articles by this author Phillip M. Pierorazio More articles by this author Mehrbod S. Javadi More articles by this author Mohamad E. Allaf More articles by this author Steven P. Rowe More articles by this author Michael A. Gorin More articles by this author Expand All Advertisement PDF downloadLoading ...